Clinical efficacy and complications of short versus long segments of internal
fixation for the treatment of degenerative scoliosis: a meta-analysis

doi:10.3969/j.issn.2095-4344.2418

Abstract

Abstract:

BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference.

OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis.

METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases. (2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle (P=0.000 4), coronal balance (P=0.000 2), Oswestry disability index (P=0.003) and visual analogue scale score (P < 0.000 01). However, the incidence of implant failure (P=0.01) and dural tear (P=0.01) in short segment group was lower than that in long segment group. The short segment group had small trauma and shorter hospital stays after surgery (P < 0.000 1). (3) There was no statistical difference in other therapeutic indicators and complications between the two groups (P > 0.05). (4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.

Key words: degenerative scoliosis, internal fixation, short segment, long segment, Cobb angle, coronal balance, meta-analysis, the National Natural Science Foundation of China

CLC Number:

R459.9

R318

R687

Sun Jian, Fang Chao, Gao Fei, Wei Laifu, Qian Jun. Clinical efficacy and complications of short versus long segments of internal fixation for the treatment of degenerative scoliosis: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(3): 438-445.

Figures/Tables 16

References

[1] XIE D, ZHANG J, DING W, et al. Abnormal change of paravertebral muscle in adult degenerative scoliosis and its association with bony structural parameters. Eur Spine J. 2019. doi: 10.1007/s00586-019-05958-7.
[2] EGUCHI Y, TOYOGUCHI T, INAGE K, et al. Analysis of skeletal muscle mass in women over 40 with degenerative lumbar scoliosis. Eur Spine J. 2018. doi: 10.1007/s00586-018-5845-0.
[3] BIRKNES JK, WHITE AP, ALBERT TJ, et al. Adult degenerative scoliosis: a review. Neurosurgery. 2008; 63(3 Suppl):94-103.
[4] LIANG Y, ZHAO Y, WANG T, et al. Precision treatment of adult lumbar degenerative scoliosis complicated by lumbar stenosis with the use of selective nerve root block. World Neurosurg.2018;120: e970-e975.
[5] PHAN K, XU J, MAHARAJ MM, et al. Outcomes of Short Fusion versus Long Fusion for Adult Degenerative Scoliosis: A Systematic Review and Meta-analysis. Orthop Surg. 2017; 9(4): 342-349.
[6] CHO K, SUK S, PARK S, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J. 2008;17(5): 650-656.
[7] FALDINI C, MARTINO A, BORGHI R, et al. Long vs. short fusions for adult lumbar degenerative scoliosis: does balance matters? Eur Spine J. 2015;24(7): 887-892.
[8] 陆海涛,袁峰,杨宇明,等.短节段与长节段固定融合修复退变性脊柱侧凸的Meta分析[J].中国组织工程研究,2016,13(20): 1970-1976.
[9] 罗益滨,王新伟,陈德玉.短节段与长节段内固定治疗退变性脊柱侧弯的Meta分析[J].中国骨与关节损伤杂志,2017,32(1):44-48.
[10] LIU W, CHEN XS, JIA LS, et al. The clinical features and surgical treatment of degenerative lumbar scoliosis: a review of 112 patients. Orthop Surg. 2010;1(3):176-183.
[11] SUN Y, SHEN Y, DING W, et al. Comparison in Clinical Outcome of Two Surgical Treatments in Degenerative Scoliosis. Cell Biochem Biophys. 2014; 70(1): 189-193.
[12] KLEINSTUECK F, FEKETE T, JESZENSZKYD, et al. Adult degenerative scoliosis: comparison of patient-rated outcome after three different surgical treatments. Eur Spine J. 2016; 25(8): 2649-2656.
[13] WANG G, CUI X, JIANG Z, et al. Evaluation and surgical management of adult degenerative scoliosis associated with lumbar stenosis. Medicine. 2016; 95(15): e3394.
[14] CHAI Y, TIAN WM, LI Q, et al. Adult degenerative scoliosis: comparison of clinical outcome, reoperation rates and survivorship after three different surgical treatments. Int J Clin Exp Med. 2018;11(8): 8446-8452.
[15] 杨永宏,郑杰,张冬生,等.长节段及短节段固定治疗退行性脊柱侧弯的比较[J].中国骨与关节损伤杂志,2009,24(7):613-615.
[16] 张国友,李明,朱晓东,等.后路减压联合不同融合节段固定治疗退变性脊柱侧凸疗效分析[J].脊柱外科杂志,2011,9(6):337-341.
[17] 张志成,任大江,孙天胜,等.退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略[J].中国修复重建外科杂志,2011,25(8):951-955.
[18] 刘胄,赵庆华,吴兴洲,等.短节段与长节段固定融合在退变性腰椎侧凸合并腰椎管狭窄症治疗的效果观察[J].中华医学杂志,2012, 92(25):1751-1755.
[19] 王华东,侯树勋,史亚民,等.退变性腰椎侧凸两种手术方式的疗效观察[J].中国骨与关节杂志,2012,1(6):574-577.
[20] 叶劲,龙厚清,陈应东,等.后路长、短节段固定结合有限减压治疗退变性腰椎侧凸的比较研究[J].中国临床解剖学杂志,2012, 30(5):568-572.
[21] 赵栋,邓树才,孙志明,等.临床症状对退行性脊柱侧凸手术方案选择的影响[J].中华医学杂志,2012,92(17):1201-1205.
[22] 何守玉,朱锋,邱勇,等. 长、短节段融合内固定治疗成人退变性脊柱侧凸并发症分析[J].中国骨与关节杂志,2015,4(3):176-181.
[23] 马超,李利,史亚民,等.不同固定节段治疗中老年人退变性脊柱侧凸的疗效比较[J].中华老年医学杂志,2015,34(11):1186-1190.
[24] 孙军,张亮.后路减压联合短节段或长节段固定融合治疗老年退变性脊柱侧凸疗效分析[J].川北医学院学报,2017,32(3):443-445.
[25] 许晨辉,何阿祥,谢栋,等.长节段与短节段固定治疗退行性腰椎侧凸并椎管狭窄的短期临床疗效分析[J].脊柱外科杂志,2017, 16(6):321-325.
[26] 马远.短节段和长节段固定融合术治疗脊柱退行性侧弯的疗效分析[J]. 河北医学,2018,24(9):1489-1494.
[27] 孟祥龙,海涌,许刚,等.退变性脊柱侧凸固定节段选择不同的矢状位力线和疗效分析[J].中华医学杂志,2019,99(5):359-363.
[28] ZHANG XN, SUN XY, HAI Y, et al. Incidence and risk factors for multiple medical complications in adult degenerative scoliosis long-level fusion. J Clin Neurosci. 2018;54:14-19.
[29] HAI W, ZHANG Z, QIU G, et al. Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study. BMC Musculoskelet Disord. 2018;19(1): 242.
[30] SILVA FE, LENKE LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3): E1.
[31] ZENG Y, WHITE AP, ALBERT TJ, et al. Surgical strategy in adult lumbar scoliosis: the utility of categorization into 2 groups based on primary symptom, each with 2-year minimum follow-up. Spine. 2012; 37(9): E556.
[32] AEBI M. The adult scoliosis. Eur Spine J. 2005;14(10): 925-948.
[33] DAFFNER SD, VACCARO AR. Adult degenerative lumbar scoliosis. Am J Orthop. 2003;32(2):77-82.
[34] CHOI SW, AMES C, BERVEN S, et al. Contribution of lateral interbody fusion in staged correction of adult degenerative scoliosis. J Korean Neurosurg Soc.2018;61(6):716-722.
[35] TEMPEL ZJ, GANDHOKE GS, BONFIELD CM, et al. Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis. Neurosurg Focus. 2014;36(5): E11.
[36] KURRA S, LAVELLE WF, SILVERSTEIN MP, et al. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J. 2018; 18(6):1014-1021.
[37] KIM DB, SHIN MH, KIM JT. Vertebral body rotation in patients with lumbar degenerative scoliosis: surgical implication for oblique lumbar interbody fusion. World Neurosurg. 2019. doi: https://doi.org/10.1016/j.wneu. 2018.12.073.
[38] 赵兴,范顺武,方向前,等.斜外侧腰椎椎间融合术治疗成人退行性脊柱侧凸的近期疗效[J].中华骨科杂志,2017,37(16):989-996.
[39] 孙浩林,李淳德,李绪文,等.多孔中空椎弓根螺钉骨水泥加强固定治疗合并骨质疏松症的腰椎退变性侧凸[J].北京大学学报(医学版), 2017,49(2):256-261.
[40] 吴爱悯,陈栋,张凯,等. 长节段固定治疗成人退变性腰椎侧凸不同近端固定椎患者手术并发症和翻修情况的Meta分析[J].中国脊柱脊髓杂志,2018,28(11):995-1003.